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Will lower doses of Lamictal and Effexor help in overcoming Cymbalta induced hypermania?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Aditya Gupta

Medically reviewed by

Dr. Vinodhini J.

Published At February 27, 2020
Reviewed AtFebruary 27, 2020

Patient's Query

Hello doctor,

I recently was on Cymbalta minimum dose but did not feel better. I felt worse and was told to up the dose then I took 120 mg, still felt bad. So I abruptly stopped this and it triggered discontinue syndrome and hypermania. I have not felt the same since. I am not suffering so much now from hypermania after a month or two. I am Lamictal and when needed on Seroquel.

On current medicines, I feel blank, unstable, unable to think normal, and some frustration, anger thinking, concentration, and speech affected at times. I feel I need to go back to antidepressants, my brain needs that and boosts mood and taper off appropriately like Effexor or Lexapro. I have had success but Lexapro cause stomach issues and Effexor is good but can cause weight gain or if working in the night it can cause mood swing. I believe my current issue is just because of Cymbalta induced hypermania. I did get psychosis from LSD. Do you think I should taper off Lamictal to Effexor low doses?

Answered by Dr. Aditya Gupta

Hello,

Welcome to icliniq.com.

Considering the history of mania (even if it is drug-induced), it is not advisable to start Effexor alone in my opinion. So, I would suggest you discuss with your treating psychiatrist regarding starting Seroquel regularly as it also acts on depressive symptoms, or starting low dose Effexor along with Lamictal (as mood stabilizer).

I hope this helps.

Patient's Query

Thank you doctor,

I cannot book in until two months to see a psychiatrist and still he does not seem to remember my history. I spoke to my doctor she suggests to stay on Seroquel though I prefer to take it when needed as it makes me groggy. So I have started Effexor lowest does 37 mg and still on Lamictal 25, though I have trying to half it as it affects my concentration and blank thoughts and response.

Though I am in a stable mood, I am with some frustration and anger at my father. My GP said to check in two weeks. Do you think this will be fine on the lowest dose of Effexor and low dose Lamictal until I taper and then taper Effexor as I do not want to be in any as it makes me emotionless. I just had relapse after a new change in work, I could not concentrate and was worrying and thinking what it is and figures it. The Lexapro helped this but has some stomach issues, then I changed to Cymbalta which I think is the worst decision and I felt worse then abruptly stopping it trigger hyper mania. So I will check in with current GP and others but also want your opinion as it is quicker.

Answered by Dr. Aditya Gupta

Hello,

Welcome to icliniq.com.

If even taking Seroquel at night causes day time sedation then the second option i.e. low dose Effexor plus Lamictal is for you. If you want to taper Lamictal first and then Effexor then maintain a mood diary and closely monitor any changes. You can also take feedback from friends and family members regarding any changes in mood (towards mania).

But in my opinion, the best thing is to maintain a low dose mood stabilizer for a long time. Seroquel, Lamictal, and Divalproex are few options.

I hope this helps.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aditya Gupta
Dr. Aditya Gupta

Psychiatry

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